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6-FACTORS AFFECTING MORBIDITY AND MORTALITY IN PERFORATED DUODENAL ULCER

Adnan Yassin Abdul-Wahab --- kassim Trayem Hayef

Basrah Journal of Surgery مجلة البصرة الجراحية
ISSN: 16833589 Year: 2011 Volume: 17 Issue: 1 Pages: 37
Publisher: Basrah University جامعة البصرة

Abstract

kassim Trayem Hayef* & Adnan Yassin Abdul-Wahab@*MBChB, Al-Sader Teaching Hospital, Basrah. @MBChB, FRCS, Assist. Professor, Department ofSurgery, College of Medicine, University of Basrah, Basrah, Iraq.AbstractDuodenal ulcer is a particular type of peptic ulcer disease that afflicts the lining of theduodenum. The indications for surgery in duodenal ulcers are; bleeding, perforation, obstructionand intractability or non-healing. Today, most patients undergoing operation for duodenal ulcerdisease have simple over-sewing of bleeding ulcer or simple patch of perforated ulcer.Simultaneous performance of vagotomy either truncal or highly selective is increasinglyuncommon because of reliance on postoperative proton-pump inhibitor to decrease acidsecretion and eradication therapy for helicobacter pylori infection. Despite of the widespreaduse of gastric anti-secretary agents and eradication therapy, the incidence of perforatedduodenal ulcer has changed little.This study aimed to assess the factors that lead to increase the rate of morbidity and mortalityin patients with perforated duodenal ulcer in different age groups and to know the effect of timelapsed between onset of symptoms and surgery.This is a prospective study that included 100 patients who underwent emergency laparotomyfor perforated duodenal ulcer during a period from May 2008 to January 2011. The operationswere done in Al-Sader Teaching Hospital and Al-Basrah General Hospital. The clinical finding,general risk factors, co-morbid medical diseases, operative finding and post–operativecomplications were all taken in consideration. Follow-up period ranged from 2 weeks to 18months.Of the hundred cases who included in this study, 96% were males and 4% were females withmean age of 43.13 years (range from 10 to more than 70 years). The disease was morecommon in rural areas (58%) than in urban areas (42%). Fifty five percent of patients gaveprevious history of duodenal ulcer and 45% had no previous history of duodenal ulcer. The mostcommon risk factors are smoking (32%) and NSIADs (25%). In this study most of elderlypatients presented with medical diseases such as hypertension, diabetes mellitus, ischemicheart disease and chronic obstructive pulmonary disease. Most patients admitted to hospitalbetween 19–24 hours (21%), (8%) admitted during 6 hours and (2%) admitted after 120 hours.Regarding the complications occurs in this study, wound infections, chest infections andparalytic ileus were the most common complications. Mortality rate was 2%.In conclusion, the most common factor that leading to development of postoperativecomplications is delayed in hospital admission, so to improve the results of treatment ofperforated duodenal ulcer, the diagnosis and treatment should not be delayed and theassociated medical illness should be treated.

Keywords

PERFORATED --- DUODENAL --- ULCER